








key: cord-316209-juvmabdq
authors: Rutayisire, Erigene; Nkundimana, Gerard; Mitonga, Honore K.; Boye, Alex; Nikwigize, Solange
title: What works and what does not work in response to COVID-19 prevention and control in Africa
date: 2020-06-12
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2020.06.024
sha: 
doc_id: 316209
cord_uid: juvmabdq

Abstract Since the emergence of the pandemic in December 2019 in Wuhan, China, as of 10:00 CEST, June 6, 2020, there have been nearly 6,663,304 confirmed cases of COVID-19 including 392,802 deaths worldwide. In Africa, as of June 2, 2020, a total of 152,442 COVID-19 cases and 4334 deaths have been reported. The five countries with the highest commutative number of cases in Africa are South Africa, Egypt, Nigeria, Algeria, and Ghana. Africa, together with the rest of world have had to swiftly undertake measures necessary to protect the continent from irreversible effects of the COVID-19 pandemic that is claiming lives and destroying livelihoods. The lower number of COVID-19 cases in most African countries is attributed to inadequate health systems, low-to-absent testing capacity, poor reporting system and insufficient number of medical staff. The COVID-19 pandemic poses a great threat to most African countries from cities to rural areas and has created a strong demand on already scarce resources and requires an intense mobilization of additional resources to implement established emergency contingency measures. Closure of borders and movements of people restrictions within the country as measures to prevent the spread of COVID-19; this has resulted in the sector being adversely affected by the loss of income. Cooperative prevention and control measures are one of the promising solutions to deplete the spread of COVID-19 on the continent.

Since its emergence in December 2019 in Wuhan, China, there have been nearly 6,663,304 confirmed cases and 392,802 deaths related to coronavirus disease as reported from 215 countries and territories (WHO Situation Report-138, 2020) . On 11 March 2020, the World Health Organization (WHO) had declared COVID-19 a pandemic, pointing to the over 118,000 cases of the coronavirus illnesses in over 110 countries and territories around the world and the sustained risk of further global spread. The rapidly evolving COVID-19 pandemic places a heavy burden on health care systems. This burden is projected to become worse in low and middle income countries already struggling with weak health-care systems, scarce financial resources as well as protective equipment, poor testing and treatment capacities, and lack of research funding (Betsch et al.,2020) . Low and middle income countries need enormous global support to prepare for impending crisis (The Lancet, 2020) and identify where they can allocate more resources to prevent and control COVID-19.

As of 9 am EAT 2 June 2020, a total of 152442 COVID-19 cases and 4334 deaths have been reported in 54 African Countries. This is about 2.5 of all cases reported globally. Since the last brief on May 26 th from Africa CDC, the number of COVID-19 cases has increased by 32% (37096 cases), this shows the burden COVID-19 could impose on African countries. As of June 2 nd , the five countries with the highest cumulative number of cases are as of South Africa (34357 cases), Egypt (26384 cases), Nigeria (10578 cases), Algeria (9513 cases), and Ghana (8070 cases) (Africa CDC, Outbreak Brief-20, 2020) . Comparatively low positive cases of COVID-19 in Africa is attributed to low-to-absent testing capacity, poor reporting system, and insufficient number of medical staff. Evidently, COVID-19 poses a great threat to most African countries from cities to rural areas (Lucero-Prisno et al. 2020) ; it has created a strong demand on already scarce resources and requires an intense mobilization of additional resources to support local emergency contingency measures in compliance with WHO and Africa CDC recommendations and directives.

The Africa continent, as with the rest of the world, continues to confirm additional cases of COVID-19. Up to now, the COVID-19 has no effective treatment and there are no available vaccines and can spread from both asymptomatic and symptomatic cases. COVID-19 is the type of infectious disease that is highly transmissible, crosses borders and threatens countries health J o u r n a l P r e -p r o o f 5 and global economy. Patients with COVID-19 especially those with comorbidities may develop severe disease and experience adverse outcomes creating additional burden to healthcare systems in place. That is why, the authorities specifically in Africa have the duty to respond to this pandemic with effective and appropriate interventions, policies and messages. At present in order to protect citizens' health, most of the African countries have activated their national health emergency management committees, special committees on COVID-19 response that are mostly chaired by ministers of health. As new evidence become available, African countries continue to share experiences and effective strategies in order to improve COVID-19 prevention and control in solidarity.

Africa Centers for Diseases Control and Prevention (Africa CDC), World Health Organization and other international agencies are providing support and guidance to many African countries in response to COVID-19 pandemic. Since the early stage of COVID-19 in Africa, many African countries have received facemasks, ventilators, test kits and other medical equipment from different countries and international agencies.

Specifically, Africa CDC is providing guidelines on contact tracing, community social distancing, Africa Joint Continental Strategy for COVID-19 outbreak and weakly scientific and public health policy updates (Africa CDC: Outbreak Brief #20).

African Union has established Africa Taskforce for novel coronavirus (AFTCOM) as a continental platform to better coordinate all COVID-19 prevention measures across the continent. Through an established task force, Africa CDC supports affected countries in surveillance by proving remote technical support to the African Union member states (Africa CDC, Feb 2020). Most African countries appreciated the importance of lockdown, closure of borders and restrictions on people's movement within the country as measures to prevent the spread of COVID-19. The lockdown has ranged between 14-60 days in most African countries.

As cases in the continent continue to rise, member states have continued to extend imposed public health measures including total lockdown in Senegal, Sierra Leone, and Zimbabwe.

Mandatory wearing of masks in public is also going on in Botswana and Rwanda. Other member states allow partial reopening of the economy and/or schools including Benin, Botswana, Cameroon, Lesotho, Djibouti, Nigeria and Burkina Faso. But, precautionary measures, such as wearing facemasks, use of hand sanitizer and gloves while maintaining social distancing remain in place.

In response to Africa CDC recommendation to reduce the spread of COVID-19, 43 African countries have closed their borders, 7 closed international air traffic, 2 imposed travel restrictions to and from specific countries and 3 imposed entry/exit restrictions. In addition, some African To protect vulnerable citizens' health, some African governments have allocated resources to cover their basic needs. For example, Zimbabwe had budgeted over $ 600 million for vulnerable households under a cost transfer program for the next 3 months; Rwanda and Ghana took 7 initiatives of providing food and other primary needs to needy population hit hard by COVID-19 pandemic. In Namibia, the government initiated the Emergency Income Grant (EIG) amounting to N$562.0 million. The grant is a once-off payment of N$750.00 in cash grant per qualifying person, on the basis of a set of eligibility criteria properly defined for vulnerable people. It is estimated to benefit up to 739,000 Namibians. Countries commit to leave no solution unexplored to ensure a healthy recovery from COVID-19 and pursue return to work strategies once the disease is under control.

Unfortunately, African countries are not complying at the same level to the COVID-19 prevention and control measures. Disparity in responses to the pandemic across Africa countries are linked to the different timing in the start of the diseases, existing lack of adequate resources for the health care, poor public health systems and community ignorance. Despite reported low case-fatality of COVID-19, the pandemic is likely to cause more deaths in Africa if the compliance to COVID-19 prevention and control measures continues to be ignored as observed in some African countries.

There is a growing concern that COVID-19 could spread further and heavily hit the African continent (Wafaa ME., & Justman J.,2020), due to the existing fragile health care and public health systems, inadequate health care infrastructure, lack of access to safe water and sanitation, lack of food safety and political instability. In Africa, one factor that could mitigate COVID-19 related mortality is its very young population demography; in fact, more than 50% of the African population is under the age of 20 years old.

However, this group of people is also surrounded by many problems including poverty, food insecurity, illiteracy and unemployment among others. Lockdown policies may put them at greater risk of getting COVID-19, lack of access to food may force them not to stay home, oblige them to go out for survival and thereafter get infected and eventually die of COVID-19.

Experience from Asia, Europe and USA showed that people with existing health problems are most vulnerable to severe cases of COVID-19. The burden of health problems in Africa is proportionately higher than the rest of the world. Consequently, the higher prevalence of J o u r n a l P r e -p r o o f 8 malnutrition, anemia, malaria, HIV/AID, and tuberculosis in many African countries may coincide with and worsen the ongoing COVID-19 pandemic prevention and control measures in Africa.

Taking into account the technical advice from Africa CDC, and WHO, most countries have taken COVID-19 pandemic seriously; cases are identified, tested and treated coupled with contact tracing in many African countries. However, there is always a delay in contact-tracing where some patients are still found in the general population having tested positive or becoming extremely difficult to trace along with their contacts. Despite the message of self-isolation and toll free number for those with COVID-19 symptoms, people in some African countries still tend to disregard the symptoms until they become severely ill. This thus increases the risk to family members in contact and the community in general.

It was observed that in some African countries, people are resisting to testing over quarantine fears. For example, Kenyans are resisting or simply not turning up for COVID-19 testing. The main reasons fronted for this behavior are that the residents are terrified of the prospect of being found to be infected, which in turn would mean being quarantined and self incurring all quarantine costs. This resistance greatly hinders Africa governments planning and interventions.

Considering the existing economic conditions of African citizens, the costs of quarantine are supposed to be paid by the government.

African countries are struggling to increase diagnostic capacity, improve infection prevention control (IPC) as well as manage confirmed cases as need arises. If the cases continue to increase, many African countries will not be able to manage those cases; there is a need for international cooperation to reduce the burden this disease will impose on African countries.

With the spread of the disease, the pandemic is dismantling gains in the social-economic fabrics of all nations and societies, and it is exposing and deepening -further emphasizing the unsustainability of previously existing weaknesses, including poverty and inequality. Some people in Africa have resisted staying home policies mainly due to cultural and religious beliefs.

Measures to impose social and physical distancing have proven to be more challenging in African countries such as Senegal and Tanzania (World Economic Forum, March 2020). It was J o u r n a l P r e -p r o o f 9 proven that during COVID-19 prevention and control measures, poor people are mostly affected.

For example, people demonstrated in Kenya and South Africa due to lack of food and sent out a clear message that they prefer to die from COVID-19 instead of hunger.

Moreover, compliance with recommended social distancing is still a problem in some places such as public markets, banks and refugee camps. In most public markets in Africa, sellers are not concerned about the risk of getting COVID-19, they are neither wearing masks nor using hand washing soap, water and hand sanitizers and sellers seem only to be interested in getting money from buyers.

Hence, we advise Africa Union member states to revisit their policies by allowing a small number of people, as it is implemented in Namibia, to enter in such markets while others are waiting outside of the facility and keeping the social distancing of about 1.5 meter, providing hand washing facilities and hand sanitizers. There is also a need to continue to inform the public on the importance of adherence to social distancing measure to prevent and control COVID-19 (Lucero-Prisno et al. 2020) . In order to ease the lockdown, African governments need to make sure that the spread of COVID-19 is mitigated by ensuring that people comprehend the significance of social distancing as well as wearing facemasks.

African countries are battling to augment diagnostic capacities, improve IPC as well as manage confirmed cases as need arises. If new reported cases persist, numerous African countries will be unable to handle them effectively. Aggressive prevention measures are one of the strategies that Africa should use to prevent more COVID-19 cases and deaths in coming months. Cooperative prevention and control measures are one of the promising solutions to deplete the spread of COVID-19 on the continent.

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None declared

